Guided Mindfulness Meditation in Substance Abuse Treatment: Transformative Approach for Offenders

1. Guided Mindfulness Meditation in SUD Treatment with Substance Abusing Offenders DR. RON MOTTERN, TCSA, 8/28/15

2. Agenda • What is Guided Mindfulness Meditation (GMM)? • Why should I care about it? • How we are using GMM • Results of using GMM • Theory • Practice • Resources

3. What is mindfulness? • Mindfulness is paying attention on purpose.

4. Origins of mindfulness • Sati is a Pali term meaning “to remember,” or, “memory,” but implies presence of mind, rather than the faculty of memory. • First translated into English as “right mindfulness; the active, watchful mind” in 1881 by Pali-language scholar T. W. R. Davids. • The corresponding Sanskrit term is smrti, and means “recollection.” • “The word sati derives from a root meaning 'to remember,' but as a mental factor it signifies presence of mind, attentiveness to the present, rather than the faculty of memory regarding the past. It has the characteristic of not wobbling, i.e. not floating away from the object. Its function is absence of confusion or non-forgetfulness. It is manifested as guardianship, or as the state of confronting an objective field. Its proximate cause is strong perception (thirasaññā) or the four foundations of mindfulness” (Retrieved from https://en.wikipedia.org/wiki/Mindfulness).

5. From religion to philosophy

6. Philosophy (and a brief hx of cognitive restructuring)

7. What is mindfulness? • Mindfulness is a form of mental training intended to enhance awareness and the ability to disengage from maladaptive patterns of mind that make one vulnerable to stress responses and psychopathology. • Training in mindfulness attempts to increase awareness of thoughts, emotions, and maladaptive ways of responding to stress, thereby helping participants learn to cope with stress in healthier, more effective ways ... (Shapiro, Astin, Bishop, & Cordova, 2005, p. 168).

8. What is GMM? • Guided Mindfulness Meditation is the facilitated experience of mindfulness. • GMM is paying attention on purpose to what is being presented to you or through you. • GMM is the facilitation of change.

9. Why should I care? • 1. It will make my job easier. • 2. See Number 1.

10. Why should I care? • 1. It will make my job easier. • 2. It will benefit the clients. • 3. It will make the community safer.

11. Self-care • Working in SUD treatment with SAO is stressful and can lead to burnout (Garner, Knight & Simpson, 2007). • Increased stress can lead to a variety of problem: • Depression, • Decreased job satisfaction, • Disruption in personal relationships, • Psychological distress, • Suicide • Decreased professional effectiveness • Decreases attention • Reduces concentration • Affects decision-making skills • Reduces ability to form therapeutic alliance (Shapiro, Astin, Bishop & Cordova, 2005). • Mindfulness can reduce stress, anxiety, and depression (Miller, Fletcher & Kabat-Zinn, 1995).

12. Self-care • MM promotes relaxation. • Benefits of relaxation: • Blood pressure lowers • Immune system functions at a higher level • Heart rate lowers • Breathe at a slower rate • Sleep patterns improve • Digestion function increases • Inflammation is reduced • AMA states that 60% of all illness is related to STRESS

13. Companies using Mindfulness • Google • Twitter • Facebook • LinkedIn • Cisco • Ford • PayPal • Aetna • Intel • Keurig Green Mountain • General Mills • Goldman Sachs • Etc. … • “‘All the woo-woo mystical stuff, that’s really retrograde…. This is about training the brain and stirring up the chemical soup inside’” (Folk in Shachtman, Wired, 2013). • “‘Meditation here isn’t an opportunity to reflect upon the impermanence of existence but a tool to better oneself and improve productivity’” (Duane in Shachtman). • “Mindfulness should no longer be considered a “nice-to-have” for executives. It’s a ‘must-have’:  a way to keep our brains healthy, to support self-regulation and effective decision-making capabilities, and to protect ourselves from toxic stress” (Congleton, Holzel and Lazar, Harvard Business Review, 2015).

14. Steve jobs and mindfulness • Steve Jobs • Jobs studied Zen Buddhism and mindfulness meditation to increase his focus, clarity, productivity, and creativity. • http://www.inc.com/geoffrey-james/how-steve-jobs-trained-his-own-brain.html • http://www.news.com.au/technology/innovation/apple-founder-steve-jobs-used-zen-mindfulness-as-path-to-success/story-fnjwubd2-1227278750216

15. Stress • Stress: Portrait of a Killer • https://www.youtube.com/watch?v=eYG0ZuTv5rs

16. Client care • GMM facilitates the use of cognitive restructuring • GMM can be used to address relapse triggers with clients

17. neuroplasticity OLD NEW The brain is plastic and can be molded Brain cells can be regenerated If part of the brain doesn’t function, other parts can compensate The mind and body are intimately connected • The brain is concrete and can’t be changed • If brain cells die then they’re gone forever • The mind and the body are two separate things

18. MM and brain plasticity

19. MM and Brain plasticity • Eleven hours of IBMT increases fiber integrity in the left anterior corona radiata (after versus before training, two sagittal sections, x = −17 and −18). (from Tang, et al., 2010)

20. mindfulness & Cognitive restructuring MINDFULNESS COGNITIVE SELF-CHANGE Cognitive Restructuring 1. Pay attention to my thoughts/feelings. 2. Identify risk in my thoughts/feelings leading to unwanted consequences. 3. Replace my risk thoughts with new thoughts that reduce my risk and move me closer to what I want in a way that doesn’t hurt me or others. • Mindfulness is a form of mental training intended to enhance awareness and the ability to disengage from maladaptive patterns of mind that make one vulnerable to stress responses and psychopathology. • Training in mindfulness attempts to increase awareness of thoughts, emotions, and maladaptive ways of responding to stress, thereby helping participants learn to cope with stress in healthier, more effective ways ... (Shapiro, Astin, Bishop, & Cordova, 2005, p. 168).

21. Mindfulness and Relapse triggers • Mindfulness can be used to address relapse triggers: • Stress (Brewer, et al., 2011; Grossman, Niemann, Schmidt & Wallach, 2004) • Anxiety (Miller, Fletcher & Kabat-Zinn, 1995) • Pain (Kabat-Zinn, 1982; Rosenzweig, et al., 2010) • PAWS symptoms, including cravings/urges (Alberts, Thewissen & Raes, 2012; Westbrook, et al., 2011 ; Witkiewitz & Bowen, 2010) • “Neuroscientists have also shown that practicing mindfulness affects brain areas related to perception, body awareness, pain tolerance, emotion regulation, introspection, complex thinking, and sense of self” (Congleton, Holzel and Lazar, Harvard Business Review, 2015).

22. Mindfulness and empathy • The purpose of this study was to investigate the effects of a Buddhist meditation intervention on empathy, perceived stress, mindfulness, self-compassion, and of particular interest, the dispositional tendency to feel empathic concern rather than personal distress when perceiving another as in need, termed altruistic orientation. Participants were randomly assigned to an intervention group (n020) or a waiting list control group (n022). Results indicated a trend towards increases in altruistic orientation in the intervention group—an increase that significantly correlated with meditation time, decreases in perceived stress, and increases in self-compassion and mindfulness. Additionally, compared to the controls, significant increases in mindfulness and selfcompassion and a significant decrease in perceived stress were obtained for the intervention group. (from Wallmark, et al., 2012)

23. Mindfulness and empathy • Empathic responding, most notably perspective-taking and empathic concern, has important implications for interpersonal functioning. While empathy training approaches have received some support for a variety of populations, few extant interventions have targeted empathic responding in couples. Mindfulness- and acceptance-based behavioral approaches, for couples as a unit and ⁄ or for individual family members ⁄ partners, are proposed as an adjunct to empathy training interventions. Preliminary findings suggest that the viability of these interventions for increasing empathic responding should be further investigated, and specific suggestions for this line of research are offered. (from Block-Lerner, et al., 2007)

24. How we are using gmm • GMM is used at the beginning of each IOP session. • Diaphragmatic breathing • Guided exercise focusing on being mindful of sensory experiences occurring in the meditation • Cts are encouraged to use MM to find the space between risk thinking and behavior allows them to use new thinking • Cts are encouraged to use skills instead of pills to deal with things such as anxiety, stress, pain, and other relapse triggers.

25. Results of using gmm • A review of program evaluations submitted by clients who have successfully graduated from one class in the IOP program indicate that the GMM is generally seen as useful by the clients.

26. theory • Diaphragmatic breathing: https://www.youtube.com/watch?v=1WMt_1jw47Q

27. Vagus nerve

28. Stimulation of the vagus nerve • Immerse your face (especially the forehead, eyes, and two-thirds of your cheeks) in cold water for three minutes. • Practice restorative yoga and include gentle backbends, forward bends, and twists. • Inversion such as downward dog or legs up the wall. • Chant and sing in low resonant tones. • Immerse your tongue in saliva while doing long deep breathing. • Practice qigong. • Laugh with deep diaphragmatic laughs (Fredrickson, 2015).

29. Practice • Breathe IN through the nose for a count of 4 • HOLD the breath for a count of 4 • Breathe OUT through the mouth for a count of 8

30. practice • Lemon Exercise (used to teach Total Behaviors)

31. Practice • Ron’s Rocks

32. Practice • The Amazin’ Raisin

33. resources • YouTube for GMM • https://www.youtube.com/watch?v=Fpiw2hH-dlc • https://www.youtube.com/watch?v=8v45WSuAeYI • Mindfulness CD resources • http://www.healthyvisions.net/ • App for mindfulness (and sleep) • CBT-i Coach • UCLA Mindful Awareness Research Center • http://marc.ucla.edu/body.cfm?id=22

34. References • Alberts, H. J. E. M., Thewissen, R., & Raes, L. (2012). Dealing with problematic eating behavior: The effects of a mindfulness-based intervention on eating behavior, food cravings, dichotomous thinking and body image concern. Appetite, 58(1), 847-851. Retrieved from http://www.researchgate.net/profile/Roy_Thewissen/publication/221767056_Dealing_with_problematic_eating_behaviour._The_effects_of_a_mindfulness-based_intervention_on_eating_behaviour_food_cravings_dichotomous_thinking_and_body_image_concern/links/54cd30c40cf24601c08cedf4.pdf • Block-Lerner, J., Adair, C., Plumb, J. C., Rhatigan, D. L., & Orsillo, S. M. (2007). The case for mindfulness-based approaches in the cultivation of empathy: Does nonjudgmental, present-moment awareness increase capacity for perspective-taking and empathic concern. Journal of Marital and Family Therapy, 33(4), 501-516. Retrieved from http://kcarrieadair.web.unc.edu/files/2014/10/Block-Lerner.Empathy_20071.pdf • Brewer, J. A., Sinha, R., Chen, J. A., Michalsen, R. A., Babuscio, T. A., Nich, C., Grier, A., Bergquist, K. L., Reis, D. L., Potenza, M. N., Carroll, K. M., & Rounsaville, B. J. (2009). Mindfulness training and stress reactivity in substance abuse: Results from a randomized, controlled stage I pilot study. Substance Abuse, 30(4), 306-317. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045038/ • Frederickson, D. (1986, May 13). The vagus nerve: An unexpected key to better performance. Breaking Muscle. Retrieved from facebook • Garner, B. R., Knight, K., & Simpson, D. D. (2007). Burnout among corrections-based drug treatment staff: Impact of individual and organizational factors. International Journal of Offender Therapy and Comparative Criminology, 51(5), 510-522. • Grossman, P., Niemann, L., Schmidt, S. , & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35-43. Retrieved from http://s3.amazonaws.com/academia.edu.documents/30863901/MBSRMAJPR2004.pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1440094987&Signature=EIlj15hp6P0e8cvxQJf8zqF21HQ%3D&response-content-disposition=inline

35. Holzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging, 191(1), 36-43. Retrieved from http://www.umassmed.edu/uploadedfiles/cfm2/psychiatry_resarch_mindfulness.pdf • Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33-47. Retrieved from http://brainimaging.waisman.wisc.edu/~perlman/0903-EmoPaper/kabatzinn-mbsr-1982.pdf • Miller, J. J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17(1), 192-200. Retrieved from http://www.psicoterapiabilbao.es/mediapool/104/1048833/data/Curso_COP/three-year_follow-up_and_clinical_implications_of_a_mindfulness_meditation-based_.pdf • Rosenzweig, S., Greeson, J. M., Reibel, D. K., Green, J. S., Jasser, S. A., & Beasley, D. (2010). Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practice. Journal of Psychosomatic Research, 68(1), 29-36. Retrieved from http://www.researchgate.net/profile/Jeffrey_Greeson/publication/40682157_Mindfulness-based_stress_reduction_for_chronic_pain_conditions_variation_in_treatment_outcomes_and_role_of_home_meditation_practice/links/00b49523d0df25001f000000.pdf

36. Shachtman, N. (2013, June 18). In Silicon Valley, meditation is no fad. It could make your career. Wired. Retrieved from Facebook • Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. International Journal of Stress Management, 12(2), 164-176. • Tang, Y. Y., Lu, Q., Geng, X., Stein, E. A., Yang, Y., & Posner, M. I. (2010). Short-term meditation induces white matter changes in the anterior cingulate. Proceedings of the National Academy of Sciences of the United States of America, 107(35), 15649-15652. Retrieved from http://www.pnas.org/content/107/35/15649.full • Wallmark, E., Safarzadeh, K., DaukantaiteD., & Maddux, R. E. (2012). Promoting altruism through meditation: An 8-week randomized controlled pilot study. Mindfulness, 4(1), 223-234. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.378.7804&rep=rep1&type=pdf • Westbrook, C., Creswell, J. D., Tabibnia, G., Julson, E., Kober, H., & Tindle, H. A. (2011). Mindful attention reduces neural and self-reported cue-induced craving in smokers. Social Cognitive and Affective Neuroscience, 8(1), 73-84. Retrieved from http://scan.oxfordjournals.org/content/8/1/73.full • Witkeiwitz, K., & Bowen, S. (2010). Depression, craving and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting Clinical Psychology, 78(3), 362-374. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280693/